Amanda J. Rogde, P.A.
Individual provider Active NPI Physician Assistant · Mendota, IL
NPI 1154423028 · NPPES record last updated Jul 13, 2007
Key facts
- NPI
- 1154423028
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- Practice address
- 1404 Washington St
Mendota, IL 61342-1471 - Phone
- (815) 538-1825
- Fax
- (815) 538-2524
- NPI assigned
- Sep 2, 2006
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 4
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in IL
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20051128000398 | IL | Practitioner - Physician Assistant | 4183644842 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 085001165 | IL | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Pic Wisconsin SC | Past |
Accepting new patients | |
| Osf Multi-Specialty Group | Past | Accepting new patients | |
| Mendota Community Hospital | Past | Accepting new patients |
Interoperability endpoints
- https://fhir4.healow.com/fhir/r4/AJDGCD/Endpoint/AJDGCD
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | IL | Yes |
Addresses
Primary practice location
1404 Washington St
Mendota, IL 61342-1471
Mailing address
1315 Memorial Dr
Mendota, IL 61342-1447
Phone (815) 539-7461
Other providers in Mendota, IL
- Donald Wilbert Piller
- Stacy A Piller
- Kenneth K Potts
- Joy Preciado
- Hollie Reppin
- Francisco Javier Romero
- Rebecca C Salvani
- David A Scholl
- Keri Lynn Sundberg
- Superior Nursing, LTD.
All providers in Mendota, IL · Physician Assistant in Illinois
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jul 13, 2007. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.